Changes in the quality of life in patients with prolonged stay in the intensive care unit and risk factors related to the changes ; Ligonių, ilgai gydytų intensyviosios terapijos skyriuje, gyvenimo kokybės pokyčiai ir jų rizikos veiksniai

Sujets

• Intensive care unit
• Medicine

Informations

• Publié par: vilnius_university
• Publié le: 01 janvier 2011
• Nombre de lectures: 90
• Langue: English

Extrait

VILNIUS UNIVERSITY


Andrius Klimašauskas



CHANGES IN THE QUALITY OF LIFE
IN PATIENTS WITH PROLONGED STAY
IN THE INTENSIVE CARE UNIT
AND RISK FACTORS RELATED TO THE CHANGES



Summary Doctoral Dissertation
Biomedical sciences, medicine (07B)




Vilnius, 2011 The doctoral dissertation was prepared at the Vilnius University in 2007 – 2011.

Scientific supervisor:
Prof. habil. dr. Juozas Ivaškevičius (Vilnius University, biomedical sciences,
medicine – 07B).
The doctoral dissertation is to be defended at the Medical Research Council of the Vilnius
University:
Chairman:
Prof. dr. Valmantas Budrys (Vilnius University, biomedical sciences, medicine –
07B).
Members:
Prof. habil. dr. Edmundas Širvinskas (Lithuanian University of Health Sciences,
biomedical sciences, medicine – 07B);
Prof. habil. dr. Kęstutis Strupas (Vilnius University, biomedical sciences, medicine
– 07B);
Prof. dr. Šarūnas Kinduris (Lithuanian University of Health Sciences, biomedical
sciences, medicine – 07B);
Prof. habil. dr. Giedrius Uždavinys (Vilnius University, biomedical sciences,
medicine – 07B).

Opponents:
Prof. dr. Saulius Cicėnas (Vilnius University, biomedical sciences, medicine –
07B);
Assoc. prof. dr. Andrius Macas (Lithuanian University of Health Sciences,
biomedical sciences, medicine – 07B).

The defence of the Doctoral Dissertation will take place at the open session of the Medical
Research Council on 27 October 2011, 2:00 p.m., in the Conference Hall of Vilnius
University Hospital “Santariškių Klinikos”. Address: Santariškių 2, LT-08661, Vilnius,
Lithuania
Summary of the Doctoral Dissertation was distributed on 27 September 2011.
The Doctoral Dissertation is available at the library of the Vilnius University.

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VILNIAUS UNIVERSITETAS


Andrius Klimašauskas



LIGONIŲ, ILGAI GYDYTŲ
INTENSYVIOSIOS TERAPIJOS SKYRIUJE,
GYVENIMO KOKYBĖS POKYČIAI
IR JŲ RIZIKOS VEIKSNIAI




Daktaro disertacijos santrauka
Biomedicinos mokslai, medicina (07B)




Vilnius, 2011
3
Disertacija rengta 2007 – 2011 metais Vilniaus universitete

Mokslinis vadovas:
Prof. habil. dr. Juozas Ivaškevičius (Vilniaus universitetas, biomedicinos mokslai,
medicina -07B)

Disertacija ginama Vilniaus universiteto Medicinos mokslo krypties taryboje:

Pirmininkas:
Prof. dr. Valmantas Budrys (Vilniaus universitetas, biomedicinos mokslai, medicina
– 07B).

Nariai:
Prof. habil. dr. Edmundas Širvinskas (Lietuvos sveikatos mokslų universitetas,
biomedicinos mokslai, medicina – 07B);
Prof. habil. dr. Kęstutis Strupas (Vilniaus universitetas, biomedicinos mokslai,
medicina – 07B).
Prof. dr. Šarūnas Kinduris (Lietuvos sveikatos mokslų universitetas, biomedicinos
mokslai, medicina – 07B);
Prof. habil. dr. Giedrius Uždavinys (Vilniaus universitetas, biomedicinos mokslai,
medicina – 07B).

Oponentai:
Prof. dr. Saulius Cicėnas (Vilniaus universitetas, biomedicinos mokslai, medicina –
07B).
Doc. dr. Andrius Macas (Lietuvos sveikatos mokslų universitetas, biomedicinos
mokslai, medicina – 07B);

Disertacija bus ginama viešame Medicinos mokslo krypties tarybos posėdyje 2011 m.
spalio mėn. 27 d. 14 val. Vilniaus universiteto ligoninės „Santariškių klinikos“ konferencijų
salėje. Adresas: Santariškių 2, LT – 08661, Vilnius, Lietuva

Disertacijos santrauka išsiuntinėta 2011 m. rugsėjo mėn. 27 d.

Disertaciją galima peržiūrėti Vilniaus universiteto bibliotekoje
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CONTENT

ABBREVIATIONS 6
1. INTRODUCTION 8
2. PROPOSITIONS DEFENDED. OBJECTIVE AND AIM OF THE STUDY 9
3. MATHERIAL AND METHODS 11
3.1. Study population 12
3.2. Retrospectively collected and assessed data 13
3.3. Prospectively collected and assessed data 13
3.4. Statistical analysis 14
4. RESULTS 15
4.1. General patient characteristics 15
4.2. Quality of life prior to admission to the intensive care unit and after
the first 6 months 16
4.3. Factors with the strongest effects on changes in health-related quality
of life 27
4.4. Effects of pre-ICU health-related quality of life on patient mortality
after ICU discharge 30
5. CONCLUSIONS 33
6. LIST OF PUBLICATIONS AND PRESENTATIONS 34
7. CURRICULUM VITAE 35
8. REZIUMĖ 36
5
ABBREVIATIONS

APACHE II Acute Physiology and Chronic Health Evaluation II score
GH General Health
GHd th Difference
CNS Central Nervous System
MV Mechanical Ventilation
MH Mental Health
MHd th Difference
VT Vitality
VTd Vitality Difference
ENMG Electroneuromyography
PF Physical Functioning
PFd Physical Functioning Difference
ICU Intensive Care Unit
CINMA Critical Illness Neuromuscular Abnormalities
2 r Coefficient of Determination
BP Bodily Pain
SAPS 3 Simplified Acute Physiology Score 3
SF-36 Medical Outcomes Study Short-Form 36
SD Standard Deviation
SOFA Sequential Organ Failure Assessment score
SF Social Functioning
SFd ctioning Difference
6
BPd Bodily Pain Difference
HRQOL Health Related Quality of Life
TISS-28 Therapeutic Interventions Scoring System-28
RE Role-Emotional
REd Role-Emotional Difference
RP Role-Physical
RPd Role-Physical Difference

















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1. INTRODUCTION
A primary goal of treatment in an intensive care unit (ICU) is to reduce mortality in
critically ill patients. The mortality rate in ICUs has long been the sole criterion in assessing
the treatment efficacy in intensive care units. Improving survival rates in critically ill
patients encouraged us taking the next step, i.e., knowing the further fate and life of
survivors after intensive care. As survivors often suffer from post-ICU consequences, they
normally cannot be regarded as fully recovered. ICU after-effects are caused by an illness
itself, organ dysfunction developed before ICU admission or acquired during a stay in the
ICU and/or prolonged intensive care support of failed organs. Organ and system failures in
intensive care may have impacts on the life of ICU survivors long after their discharge from
the ICU. Frequent post-ICU effects include limitations in the ability to work and performing
the activities of daily life, organ dysfunction and/or impaired mental function. However, to
evaluate the quality of health and life in such patients as a whole, mere objective
information on the patient‟s ability to work and mobility as well as clinical or laboratory
analyses of organ functions are not enough. Impairment or even disability after discharge
from intensive care may as well have no effects on the health and life satisfaction for ICU
survivors. Subjective perception of the physical and mental quality of life by patients
themselves becomes more and more important for the evaluation of post-ICU outcomes. A
combination of patient‟s health status and multiple non-medical aspects reflecting well-
being is defined as health-related quality of life (HRQOL). Data suggest that for intensive
care patients whose HRQOL was poorer prior to ICU admission, as compared to that of the
population, further reduction in HRQOL scores was also observed after their discharge from
8
the ICU. HRQOL improves 9-12 months after ICU discharge. Poorer HRQOL after
intensive care is influenced by factors related and unrelated to illness, health state upon ICU
admission and ICU-related factors. Such illness-related factors as sepsis, multiple organ
dysfunction and respiratory distress syndromes have been also reported to have negative
implications for HRQOL in ICU survivors. ICU-related factors have the strongest effects on
long-term ICU patients. Some data also suggest that a long stay in the ICU affects some
domains of HRQOL. Physical activity and viability are most commonly impaired domains
of HRQOL in patients after cardiac surgery and in other post-operative patients staying in
the ICU for longer periods than usual (5-7 days). Knowing the factors affecting HRQOL in
patients staying in the ICU longer than usual would enable prognostication of patient health
state after discharge from the ICU. In turn, the above-mentioned prognostications would
help to reduce or even eliminate the effects of the factors on HRQOL in ICU survivors. In
order to identify these factors and assess their implications for HRQOL, we conducted a
study of changes in HRQOL for long-term ICU patients.

2. PROPOSITIONS DEFENDED. OBJECTIVE AND AIM OF THE STUDY
Propositions defended
 A long stay in intensive care units reduces HRQOL in ICU survivors.
 HRQOL is influenced not only by health state upon admission to the ICU, but also
by the course of intensive care treatment and health state upon discharge from the
ICU.